The Lift That Borrows From Itself: An Auto Augmentation Read

Greyscale editorial photograph for an auto augmentation breast lift essay by Frank Agullo, MD, FACS.

A version of the same request walks into my clinic every few years wearing new clothes. These days, the lines sound something like this: “I want more volume, but I do not want anything artificial inside me.”

There is a real procedure hiding behind that line, not just some newfangled marketing gimmick, and it is worth explaining plainly and clearly what it is.

The Idea, Stated Simply

An auto augmentation breast lift uses tissue the patient already has and reshapes it to gain a little bit of volume that goes predominantly into the upper pole, during a breast lift. There is no implant involved. When they have plenty of tissue (usually after some weight loss), I use tissue from the breast and sometimes from the lateral chest wall.

To maintain the shape, I incorporate a GalaFLEX mesh, which functions as an internal bra and helps hold everything perfectly in place. It forms a nice capsule, similar to how an implant’s capsule works, allowing the volume to sit high and circular post-lift, but without any artificial device.

What It Will Not Give You

This is the part where I get blunt with patients like this. Any marketing you see for ‘natural augmentation’ is basically overselling this technique, so I make it clear up front just what someone looking for an operation like this should and should not expect. Implant-level upper pole cleavage does not occur utilizing your own soft tissue, which has more tendency than implants to eventually soften over and reshape. The result is a more tapered, natural-looking upper pole. If anyone starts talking to me about hoping for significant, round cleavage, I clarify that this operation simply will not achieve that, even before we consider booking.

The patient population who really shines with this technique are massive weight loss patients. There is real tissue left to begin with, but almost certainly, not enough structure underneath to maintain an upward position. We take care of that structural problem with this, no device needed.

The Technical Trade

I perform with the same Wise pattern or anchor incision pattern I use for any full mastopexy. The difference with auto augs is that I carry the incision laterally. So, for mastopexy, I extend to the area underneath the armpit, then elevate that skin portion before lifting it to form a nice contour. After elevating the skin, I then add some internal sutures to try and redistribute parenchyma over, and once all that is done, I raise my mesh higher on the patient than I would in a typical implant placement to assist with further support. This way, we put gravity to less of a test going into the future. That also goes for women having a mastopexy, for example, from an implant explant.

I would say for patients, it is pretty much a one-or-the-other consideration, having the auto aug is not an add-on option to any plans for implants. The options are either a mastopexy with an implant or a mastopexy with auto augmentation. I have not found any clear, viable way of doing combined operations on the unique individual. And what is more, I would not pretend otherwise with a patient that is actually asking for exactly that when she approaches me.

Recovery, No Surprises

Recovery is much like that for any similar breast lift. A week to light duty. Four weeks light exercise and normal life. Then four weeks full exercise, no holds back. There will be bilateral drains, which come out around a week after the surgery. Then there is an anti-underwire, anti-push-up, supportive bra regimen, which lasts a while beyond that and for the laundry too; it is a two-bra situation all the way with this one so the clothes pile does not pile up!

The Honest Limitation

Long-term durability with an auto-augmented breast lift, even without implants, comes down to the same constraints as any similar breast procedure: The longevity or durability will be the same after the procedure, including even when implants are present later in life, provided no changes are made to the patient’s weight or body condition. We are talking weight changes including swings, gaining it and losing it later, and in particular to pregnancy; it moves the result same way any other lift will be displaced.

Why I Reach for This Technique

As a Mayo Clinic fellowship-trained and double board-certified plastic surgeon and a Castle Connolly Top Doctor for thirteen consecutive years, I see plenty of and perform a lot of post-weight loss reconstruction. That is why an auto augmentation earns its place within the population with some added specific conditions. The truth is that when you have a support problem and can actually take care of that particular problem with the technique, without a need to add a foreign body to your body when an implant could just be avoided, a patient who has just gone through sufficient amounts of change might just really end up being the best candidate for this treatment which can give her more stability. All the way from incision to what needs to be considered, see the full guide on agulloplasticsurgery.com.

Ready to Talk?

If your own tissue can do the job, let’s find out before anyone talks you into a device it does not need.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. #StayBeautiful

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

Cross-links

Full surgical guide on agulloplasticsurgery.com: “Auto Augmentation Breast Lift: A Fuller Lift Without an Implant” (canonical)
Med spa side on swplasticsurgery.com: “No Implant, Still Fuller: The Auto Augmentation Lift at Southwest Plastic Surgery” (link once live)

August 19, 2026

The Destination Nose: Why My Rhinoplasty Patients Fly In

Greyscale editorial photograph for a destination rhinoplasty essay by Frank Agullo, MD, FACS.

In most such visits, the patients begin by apologizing for the commute. “I am sorry that it is far away,” they begin from their homes on screens in Seattle, Toronto, or, on one occasion I still recall, Dubai.

This is what I tell them: the nose does not care what city it is in. Eighty percent of my patients come from out of town now. Texas and New Mexico send the most, then New York, California, Florida, and Seattle, a whole contingent from Canada, and international patients from as far away as Japan.

Your travel time is nowhere near the barrier to be, but there are specific factors you will need to assess before committing to travel for your surgery. Let us be clear: honesty wins out.

What Travel Does Not Change

When you look, every checklist you see is the exact same. Board-certified plastic surgeon, either in general plastics or facial plastics, that specializes in rhinoplasty (this is key; they do them over and over, unlike a plastic surgeon that rarely works on noses). Make sure it is an accredited surgery center. You want to look for a long string of before-and-after photos of noses just like yours and to see happy patients whose problems look just like your potential problem. If you can talk to any former patients, then you will really get good information.

I published the full checklist, plus how our process works step by step, in the complete Texas rhinoplasty guide on the practice site.

What Travel Actually Changes

Logistics. Solely logistics. The patient will consult from her country. 3D simulation of the case will be completed entirely in my virtual office. By the time she boards an airplane, we have worked through the Surgical Plan piece by piece and agreed on the plan. Pixel by pixel.

From there, your personal coordinator handles the remaining details, such as arranging your hotel, surgery booking, nurse visit after your surgery, post-op appointments and virtual check-ins after you return to your home country. My patients are actually scheduling their rhinoplasty similar to scheduling their vacation with one mandatory and the most crucial meeting in the middle.

And the framing’s not inaccurate. It would take about a week, no matter where you went, to recover at home after a rhinoplasty. And again, this comes down to bias on my end, if I were going to hide out for a week, West Texas sun and Texas cuisine sound as good a place to do it as any.

The Simulation Is the Contract

Here is the part of my process I would defend to any colleague: nobody gets on a plane until the simulation is settled.

My patient and I edit using VECTRA 3D and Crisalix, determining their goals, what they find undesirable, and what is realistic for their particular body type. By the time we agree on a plan, we are entirely in accord and the image will then be utilized over the coming year as our visual guideline through the healing process.

This is even more important in ethnic rhinoplasty, which is 30 to 40 percent of what I do. Some patients prefer a more Western profile; others just want a refined version of their own nose.

The simulation forces that conversation to happen before surgery, where it belongs. And the image bypasses language differences entirely, which matters in a bilingual border practice where my patients move between Spanish and English.

The Year After

Distance is irrelevant; it generally takes one full year for rhinoplasty to heal. The residual swelling will dissipate and the nasal tip will relax as the healing process reaches its final stage, which takes one year to become apparent.

That should be a check on the vetting list. You will have spent more hours on your surgeon than on virtually anyone else over the year; pick someone you are willing to see more than one more time. Do not pick someone whom you barely tolerated in one single visit.

It really is not too hard; I wrote the rough range prices I had down on paper in there: real-deal prices for plastic surgery and what makes them so.

Ready to Talk?

The consultation is virtual. The simulation is virtual. The only thing that has to travel is you, once.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. #StayBeautiful

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

Cross-links

“Rhinoplasty in Texas: Why Patients Cross the State (and the Border) for a Nose” can be found on agulloplasticsurgery.com. Southwest Plastic Surgery also offers an out-of-town program, which will be linked here once it goes live.

August 17, 2026

Ballerina Breasts: Why Half My Patients Now Ask for Smaller Implants

Greyscale editorial photograph for a smaller breast implants essay by Frank Agullo, MD, FACS.

Trends hit my field like 12 months after they came to the runway. This one came early.

Patients started picking up a description I had never put into their mouths, the phrase “ballerina breasts.” They were “working breasts,” they had a nice shape to them. Smaller. Lighter. The size the breast would be on its own. Not flat. Not androgynous. Just quiet.

Let me be precise about the numbers, because the internet is not. In my practice, approximately half of my patients still desire the largest sizes and they are getting amazing outcomes. The other half has moved, and moved decisively.

The Cup Size Secret

The single math lesson that informs how every size conversation I have ever been in ever unfolds is that 150-200cc implants equate to one full cup size.

The patient arrives saying some version of “a small implant will not change my appearance much.” Then, on the 3D simulation of their own body, I show what 150 cc of change does and ask for comments. You can hear crickets. Even that little volume dramatically impacts projection and cleavage. 150 cc is not a minor change.

I often turn to Motiva Ergonomix when addressing these situations. It mimics the movement and contour of breast tissue: It is rounder while flat and takes a teardrop shape when standing, which appears more natural in motion for its size.

Getting More From Less

Placement of the implant is key: Traditionally placed, it leads to a standard augmentation with a size difference that makes sense relative to the individual’s natural breast size. Under ligaments using the Motiva Preserve approach, it causes the ligaments to support the implant and not cause a “hang” or “unnatural feeling” because nerves, vessels and breast tissue are all left alone; a size is chosen that yields a breast size higher than what might be expected just from the cc count itself.

When I place implants the traditional way, I often add a DuraSorb or GalaFLEX mesh that essentially acts like an internal push-up bra. That placement is secure and lowers the risk of capsular contracture and migration. With Preserve, the breast’s own ligaments achieve this same purpose, for free.

I cover the full surgical walkthrough, along with the downsizing pathways, in the complete smaller implants guide on the practice side.

The Downsizing Wave

These ladies are more interesting because they are not fresh to cosmetic surgery. They are 50- and 60-something women who chose large implants decades ago and now feel they are simply too big to wear.

It is serious surgery with real planning involved. If you plan on dropping only one cup size, you might be fine just taking out the old implant and inserting the new, smaller one. If you are dropping larger sizes, the skin will likely be too saggy and would have to be worked with. This usually takes a shape similar to a “donut lift” or an “anchor lift.” Finally, the now empty space/pocket from the old larger implant needs to be pulled tighter, closed up with some mesh to keep the new, smaller implant from moving out of place or shifting. Skipping it is what turns a downsize into a future revision.

What It Costs to Go Small

That smaller size does not result in a smaller bill, and I would prefer to say so plainly rather than mislead anybody. It is still the same surgery and the same amount of carefulness in that surgery. I went over all the details and costs in my breast augmentation cost read.

Going small might buy some time, as there is much less weight pulling your breasts down as you age and maybe a result that never needs a lift at all. It will also, as many patients say, be much more comfortable to get around.

My Honest Take

Two major waves of breast augmentation fashion have rolled through my professional life. The choice of size should be the patient’s, not the surgeon’s dictation. The physician’s role is to inform the patient of realistic tissue constraints, outline available alternatives via a 3D visual model and then allow them to hold implant samples in their own bra to estimate weight before they go under the knife.

Ballerinas are not even close to a downgrade. If done right with the right type of implant and support, they are honestly some of the most detailed cases that I can do. One recent example is in the 315 cc Motiva Preserve case study.

Ready to Talk?

Bring your version of “natural” and we will find out together what it looks like on you.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. #StayBeautiful

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

Cross-links

Full surgical guide on agulloplasticsurgery.com: “Smaller Breast Implants in El Paso: The Ballerina Breast Trend, Downsizing, and the Preservation Approach” (canonical)
Consultation-experience version on swplasticsurgery.com: “Trying On Your New Size: How Southwest Plastic Surgery Plans a Smaller Breast Augmentation” (link once live)

August 15, 2026

Why I’ve Never Hidden My Prices

Black and white photograph of a woman in a robe reading a medical practice website on a laptop at night, illustrating clinic website transparency commentary by Frank Agullo, MD, FACS.

For weeks, a researcher investigated 200 aesthetic clinic websites in the UK to see whether they explained: what the procedure entails; how you will be recovering; who is the ideal candidate; and what the inherent risks are. She messaged me on Connectively (which is a platform where journalists and researchers reach out to working professionals for quotes) and asked for me to provide input about her findings based on my medical position.

I read her data before I answered; 96 out of the 200 were sites that did not offer information about risk nor suitability of the treatment. 77 of the 200 had all four of the basics (what it involves, recovery, suitability, and risk information) on a single page. Just over half offer you a chance to book the treatment before looking up any information about it. 6 of the 200 give you a chance to ask a question before entering your telephone and e-mail.

Six out of two hundred.

What I Actually Told Her

“A clinic’s website is not doing its job if a patient has to call just to learn the specific risks of a given procedure, whether they might be a poor candidate for it, and the name and credentials of whoever is actually performing the treatment. If a page cannot answer those questions within a few minutes, that gap is more about the clinic’s priorities than its web design.”

I would tell that to each of the 200 clinics she reviewed.

The Part I Can’t Stop Thinking About

It is the booking number. 51% will take your deposit or book your consultation without you first reading a word about risk or candidacy. No, this is not unintentional. At some marketing meeting, someone decided the book button belongs above the information you need to have.

My stance has been on the opposite side for some time. The pricing is plainly posted on my website: agulloplasticsurgery.com/fees. This is an actual list of starting figures that are all-inclusive (excluding only your prescriptions) available before any conversation or call takes place. This is not because price is the singular factor to consider, it is not, nor should it be, but websites that necessitate a phone call before revealing the cost of a procedure were designed to snag patients before they have had adequate time to contemplate it.

Where This Goes From Here

Not sure if a UK audit changes anything for the clinics included. What it does confirm about my practice though: share the information and prices openly. That leaves the consultation to discuss the patient rather than extracting basic details by phone.

Ready to Talk?

Call (915) 590-7900, text the consult line at 1-866-814-0038, or check my published prices at agulloplasticsurgery.com/fees before you ever pick up the phone. Find me as @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

Companion reads: the patient-facing version on agulloplasticsurgery.com and the practice story on swplasticsurgery.com.

August 13, 2026

Where the Fat Goes: The Science of BBL Survival, From My OR

Moody greyscale photograph of a woman resting face down on a recovery lounge in a surgical compression garment. BBL fat survival science explained by Frank Agullo, MD, FACS, Dr. WorldWide.

Every BBL I consult ends the same way: “So, how much of that fat stays long-term?”

Patients arrive from the internet convinced the fat basically just melts away. Colleagues outside the field ask because they suspect the results will not last. Both parties have a mistaken perception of what the surgery does, so here is the answer I would give across the conference table: the biology.

The Number, and Why It Is a Range

Fifty percent to eighty percent. So the difference is a 30% span? Yeah, that is kind of the magic. But that difference is not random; there is really little random variance from one patient to another.

A fat graft is living tissue that comes from the recipient. I took fat tissue that had its blood source detached, squeezed it through a syringe-like tool called a cannula and then put it in a place where it can only rely on diffusion to get to nutrients for the first 2 weeks until it is able to build a blood supply. The tissue that successfully reattaches will last for the next few decades. In contrast, the tissue that did not attach will simply be absorbed into your body, resulting in volume loss.

It is much more than just moving tissue. Every decision the surgeon makes is focused on making sure those cells can live on for two weeks.

The Wash Most Patients Never Hear About

Surgeons often want to see my fat-washing protocol more than any other piece of my entire fat-grafting procedure. And before all that nice soft fat goes back to the patient, I am washing that fat thoroughly with AuraClens, a solution that contains Poloxamer 188.

What is the best way? First is housekeeping. When you get lipoaspirate harvested from patients, it is not clean: it includes tumescent solution, free oil due to burst adipocytes, as well as dead adipocytes. This process removes the sludge to deliver a concentrated product of viable cells. Each cc injected contains the maximal amount of living fat possible. Now you double pay when you inject nonviable debris. That mass will disappear as the cellular detritus dissolves, and this trash creates a massive amount of inflammation among the living adipocytes attempting to survive.

The second benefit is the one worthy of a journal club. Poloxamer 188 is a membrane-active surfactant; it does more than simply scrub/clean the membrane. What makes it so unique is how it actually works to repair and stabilize the adipocyte membrane, essentially patching up damaged holes in cell walls and making them resist apoptosis, the programmed self-destruction that stressed adipocytes would carry out, whereas the ones scheduled for elimination instead just keep kicking along.

The Patient’s Half of the Equation

I can scrub and prep the fat perfectly and still lose the graft to a barstool. Pressure destroys grafts in the first two weeks, which is why my sitting protocol is non-negotiable. For two weeks: nothing hard under the buttock, a BBL cushion shifting the weight onto the thighs for any sitting, and stomach sleeping, or a wedge-supported beach chair position for anyone who cannot manage the stomach.

The other patient-side lever is the massage table. Lymphatic drainage two, preferably three times a week for the entire first month, and honestly as often as the schedule allows: it works scar tissue and fluid out of the donor sites. My patients run theirs through the post-surgical massage program at Southwest Plastic Surgery. It is an unsexy part of the operation and the one that makes the most substantial difference in the final contour.

The payback comes fast. Final volume is essentially there at week four, when every restriction lifts, and the settled result is declared at three to six months. Out-of-town patients, most of my practice, fly home on day five.

What I Tell Colleagues About the Long Game

If the fat makes it through its first month, it is no longer vulnerable. It is permanently on the payroll and it behaves like fat behaves. Weight loss will cause it to shrink; weight gain will cause it to expand. The ruined results I occasionally witness are almost never a result of the surgery itself. They are yo-yo cycles, losing and regaining weight, which stretch out the skin, sag the mound I painstakingly created, and leave contour issues that no revision entirely fixes.

For all my fellow plastic surgeons: We choose our patients not only for their anatomy but also for their understanding of what it will take to maintain results. Before an op, tell those considering significant weight fluctuations that the size of their gluteal graft will inevitably follow their weight journey. The full patient-facing timeline, week by week, lives on my practice page for the Brazilian butt lift.

Where I Sit in This Field

The procedure itself started to really coalesce as an entity in the last 10 years, partially through my contribution, as I am a founding vice-president of the World Association of Gluteal Surgeons. Back then, all you heard about was the normal BBL; now you have the ultrasound-guided BBL and the supercharged BBL, which pairs fat grafting with intramuscular implants. That means you have a variety of approaches just as rhinoplasty now has different styles to choose from and all of them stem from the science behind the survival.

The Mayo Clinic taught me to treat every graft like the transplant it truly is. The liposuction that harvests it, the wash that protects it, and the two weeks that anchor it are one operation, not three separate events. Surgeons who treat them separately end up stuck at the fifty percent end of the range, wondering why.

Ready to Talk?

Whether you are a patient counting weeks or a colleague comparing protocols, my door is open.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

Cross-links

Week-by-week patient guide on agulloplasticsurgery.com: “BBL Recovery Week by Week: What Actually Happens After a Brazilian Butt Lift” (link once live)
Aftercare version on swplasticsurgery.com: “The Aftercare That Makes a BBL: Massages, Garments, and the Two-Week Rules” (link once live)

August 10, 2026

I Had Kybella Myself: A Surgeon’s Honest Read on the Fat-Dissolving Shot

It surprises people every time: the plastic surgeon telling you to think twice about Kybella has had Kybella under his own chin.

I remember the first time turkey neck started creeping into the mirror, a few years back. So I took my own advice: one session, my own central pocket, my own experiment. This means I am not reviewing a brochure. I have been the injector, the surgeon who performs the more definitive operation, and the guy sitting in the chair.

The Three-Chair Review

It looks elegant. Your body already produces a form of deoxycholic acid. It is how your gut processes fat in your food. If you make a more concentrated version, inject it into the submental fat pad, and it kills the cells. The cells will burst and then be cleared out. Fat-cell-killing fact. Destruction is permanent, those cells do not come back.

Lying back, less glamorous. You get a bunch of injections that really burn. That is where the “unseen part” of this whole trend begins. You get swollen up to where you have a more janky turkey neck than the one you paid to fix up and it will be a while before the effect starts showing. Two to four weeks is how long you can expect, or even longer. Now remember, that was after just one treatment and people generally get three sessions.

Looking at it from the doctor’s standpoint, it is a basic sum: Twenty percent of the central fat compartment is eliminated with Kybella. CoolSculpting likewise eliminates about twenty percent, except it freezes the fat instead of dissolving it, and I like it even less. In terms of effectiveness, even on a strong candidate, twenty percent of the single center compartment reads as a subtle change at best. On the wrong candidate, it reads as nothing.

Who the Shot Actually Fits

My peers and I may squabble a lot on many of the above issues, but Kybella candidature has little debate among people performing these procedures daily.

You want superficial subcutaneous fat, directly underneath the skin, not below the platysma muscle. The needle is too short to reach that far and the ads do not mention it, which is one of the reasons why it makes some people look worse. It needs to be mostly in the mid neck region. Lateral neck fat and jowls are off the map. The skin quality must be of good elasticity to take the deflation of fat within; if you just remove the fat below loose skin, you will have a worse neck.

A younger individual with elastic skin has one specific, isolated fat pocket right in the middle. That patient does exist, and for that person the Kybella program at our med spa is a legitimate option.

What I Do for Every Other Neck

In most necks walking into the office, the fat has migrated beyond being a simple neck issue and has already wrapped around the jawline, spilled onto the sides, or the skin has been relaxed for a long time. So for that patient, for many years, my solution has been neck liposuction combined with FaceTite.

It is not even close. Liposuction takes out up to 80% of the excess fat and treats the entire aesthetic unit (lower face, jawline, center neck, sides of neck). FaceTite runs RF underneath the skin through the same 3 little entries, one behind each ear and one below the chin, and tightens the envelope up as the volume drops. A real neck lift is the choice when the problem is larger than a single energy device will help, point-blank!

Plus, it all costs about as much as three sessions of Kybella. It is not like people were choosing cheap versus expensive. They are deciding between 20% off of one pocket versus 80% of the entire neck for the same price.

The Part I Trained For

The Mayo Clinic taught us that the diagnosis IS the surgery. The neck is our classic teachable moment. Is the fullness fat or gland? Is it above the platysma muscle or below? Is the neck fullness a narrow strip down the front or has it completely encircled it? Is the overlying skin a bystander or the focus of pathology?

They all swap out the correct tool, not that these questions could possibly be found on a spa menu, nor that 90 seconds’ worth of exam would not find the best tool. Ninety seconds is the most important part of every consultation on necks, even mine. This is precisely the reason I keep both the needle and cannula within arm’s reach of the procedure, rather than deeming one “king”.

My Bottom Line

Kybella is real. The science is sound, the fat it kills stays dead, and my own neck carries the proof years later.

However, in a one-pocket room, the shot has a ceiling of 20 percent, and most necks need more than that. When someone only talks about a particular needle treatment that is the only thing a clinic is willing to offer, they are not telling you what a treatment is supposed to be; they are telling you about an ingredient they offer.

Ready to Talk?

Bring me your neck and ninety seconds. I will tell you which chair you actually belong in.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

Cross-links

Med spa version on swplasticsurgery.com: “Kybella in El Paso: What the Fat-Dissolving Shot Can and Cannot Do” (link once live)
Surgical version on agulloplasticsurgery.com: “Why I Still Reach for Liposuction and FaceTite Over Kybella” (link once live)

August 6, 2026

On the Cover of Women’s Journal: The Scar-Free Facelift

July 2026 Women's Journal cover featuring Dr. Frank Agullo and the scar-free facelift story.

The July issue of Women’s Journal is their Face Issue. The cover is me, arms crossed, in a #StayBeautiful shirt, next to a quote I have said in the operating room more times than I can count: the best results are the ones no one can point to.

Strange feeling, seeing your own sentence printed in serif type on a magazine rack. Also a useful one. Because the story they chose to tell is the story I have been trying to get patients to hear for two years.

Not a new machine. Not an injectable. A facelift you cannot see.

What the Cover Story Actually Covers

The piece, written by Adriana Sinclair, is about the ponytail lift, which is the nickname for what I perform as a total endoscopic deep plane facelift. The name comes from the incision placement. The openings sit so far back inside the hairline that a patient can pull her hair into a high ponytail or a bun without showing a single mark.

No cut in front of the ear. No scar tracing the earlobe. None of the tells that made facelifts recognizable for fifty years.

Instead of lifting skin, I thread an endoscope, a camera thinner than a pencil, beneath the surface and reposition the deeper layers of the face: the brow, the midface, the jawline. The skin comes along because the foundation under it moved, not because I pulled on it.

If you want the full technical walk-through, I wrote it up in April in The Facelift You Can’t See. The Women’s Journal piece is the patient-facing version of that argument.

Tension Is the Enemy

Here is the opinion that runs through everything I do to a face. Tightening skin and adding tension is what creates the pulled, wind-blown look every patient says they are terrified of. Skin is a cover, not a scaffold. Treat it like a scaffold and it tells on you.

The deep plane approach, open or endoscopic, moves the structural layer and lets the skin settle where it belongs. That is why the results read as rested instead of redone. It is also why they hold. Repositioned tissue stays put in a way stretched skin never will.

Surgeons argue about plenty inside this space. How deep, how wide, on whom. I have been in those rooms, including at The Aesthetic Meeting in Boston this spring. But the direction of the field is not really in dispute anymore. Deep plane won.

Training With the Man Who Invented It

The cover story spends time on something I insist on being transparent about: where I learned this.

The ponytail lift was created by Dr. Chia Chi Kao in Santa Monica. I took his intermediate course in Pittsburgh, then applied to the advanced Ponytail Academy, the invitation-only program held at his own operating suite in Santa Monica, and was accepted.

Those days are not lecture-hall days. Cadaver lab on the midface. Live demonstrations of endoscopic tissue elevation. Long arguments about candidacy, because knowing who not to operate on is most of the job.

I brought all of it back to my AAAASF-accredited practice in El Paso, where it joined what Mayo Clinic fellowship training and twenty years of facial surgery had already built. That stack matters. A technique is only as good as the hands and the judgment around it.

Who the Ponytail Lift Is For, and Who It Is Not

Surgeon to reader, candidly: this operation is not for everybody, and any surgeon who tells you otherwise is selling.

The endoscopic version shines for patients who want the brow, midface, and jawline lifted discreetly, typically earlier in the aging curve, before heavy jowling and significant loose skin take over. For a patient with a lot of skin excess, a traditional open deep plane facelift remains the stronger tool, and I offer both, which keeps me honest. When you only own a hammer, every consult looks like a nail.

Recovery between the two is similar. Both rely on repositioning deeper tissue rather than surface tension, which is exactly why both are built to last.

Why a Magazine Cover Matters to Patients in El Paso

There is a line in the piece I want to underline. El Paso used to be a city people left for this kind of surgery. That has reversed. More than eight in ten of my facelift patients now travel to El Paso from out of town, from across Texas and the rest of the country.

A national cover story is not why they come. They come for the work. But the cover is a signal that the work happening on the border is being noticed at the national level, and I am proud of that for my city, not just for my practice. I see patients in English and Spanish, often in the same hour, and that bilingual, binational room is part of what makes this practice what it is.

Thirteen straight years as Best Plastic Surgeon in El Paso. Castle Connolly Top Doctor thirteen consecutive years. Texas Super Doctors Hall of Fame. Those lines have lived on my CV for a while. Seeing the philosophy behind them on a newsstand is new.

The Quote I Will Stand Behind

“The best results are the ones no one can point to.”

That is the whole preservation-first argument in eleven words. If someone can tell you had a facelift, something went wrong: too much tension, too much volume, wrong plane, wrong patient. The win condition is a colleague saying you look well rested and meaning it.

Women’s Journal put that sentence on a cover. My job is to keep making it true one face at a time.

Ready to Talk?

If the cover story raised questions about your own face, let’s answer them properly, in person. Call Southwest Plastic Surgery at (915) 590-7900, text my consult line at 1-866-814-0038, or book through agulloplasticsurgery.com. Find me as @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

Companion reads: the patient-focused version on agulloplasticsurgery.com and the practice story on swplasticsurgery.com.

June 4, 2026

The Title She Defended Three Months After Surgery: Stephanie Han, Motiva Preservé, and the Recovery Her Coach Never Noticed

WBA lightweight champion and El Paso police officer Stephanie Han, a Motiva Preserve breast augmentation patient of Dr. Frank Agullo, MD, FACS, at Southwest Plastic Surgery in El Paso, Texas.

Saturday night, Stephanie Han defended her WBA lightweight world title against Holly Holm at the El Paso County Coliseum, live on ESPN, and won by decision. She is 13-0. About four months earlier, she was on my operating table for a breast augmentation, and nobody in her camp knew.

We sat down together to talk through how that was possible. Our conversation is below, in her words and mine.

Your Body Is Your Livelihood. Why Did You Decide to Do This?

Stephanie: “It’s something I’ve wanted to do for a very long time, and I always held back because of the stigma, that you shouldn’t do it because it’s going to affect your performance as a professional fighter. But I did my own research and realized I can still perform at an elite level. Most importantly, I’m doing it for myself. I don’t ask for a lot of things in life. This is personal.”

You’re a Mom of Two Who Breastfed Both. How Did That Factor In?

Stephanie: “I’m a mom of two beautiful kids, and I breastfed both of them. No one tells you your breasts won’t be the same afterward. I could train, I could do a million push-ups, and it would not change this. This was probably my biggest insecurity. I knew if I got it done, it would boost my confidence and make me feel comfortable in my own skin again.”

What Makes Motiva Preservé Recover So Differently?

Dr. Agullo: It comes down to where the implant sits and how we get there. We make a small incision in the fold, about two and a half centimeters, and we open the pocket above the muscle, behind the breast gland. There is no cutting and no electrocautery. We use a balloon to create the space, so we are just pushing the tissues outward and letting the breast’s own ligaments hold the implant. We preserve the nerves and the arteries, and because the muscle is never released, the recovery is fast. We do not even need a mesh. Most patients are back to work the next day and back in the gym in about two weeks.

Her Implants Were Not a Matched Pair, Were They?

Dr. Agullo: No, and that is part of the artistry. Stephanie had a meaningful difference between the two sides, which is very typical, since we all have an asymmetric side. On the 3D simulation we planned a 265cc Demi Ergonomix on the right, with a little less projection, and a 315cc Full Ergonomix on the left. The Ergonomix implants move with the body, so they fill in beautifully and read as symmetric, even when she cuts weight for a fight.

What Was the Recovery Actually Like?

Stephanie: “Dr. WorldWide told me I’d be fully recovered in two weeks, and honestly I didn’t believe it until it happened. I had maybe a little discomfort for about three days, and after that it felt amazing. It’s been about four months and it truly feels like I didn’t get them done.”

Back in Camp Four Months Later. How Did Your Body Hold Up?

Dr. Agullo: I was surprised she never told her coach, but it made for a perfect test, because he was blinded to it. He watched her spar and train for the whole camp and thought she was in the best shape he had ever seen. That tells me the augmentation did not get in the way of her performance, her strength, or her range of motion, which is exactly the point of Preservé.

Stephanie: “Today I sparred 12 rounds and there was no pain. I can run seven miles, no problem. It feels like nothing, like they’re not even there. It’s maybe a pound of extra weight, and it feels like part of my body.”

Does That Mean the Surgery Helped Her Performance?

Dr. Agullo: No. The implants did not make her a better fighter. They boosted her confidence enormously, she does not stop talking about them, but they did not change her fighting. The whole point is that they did not affect it. They did not make her worse. That is what makes this such a good illustration of what the procedure can do for athletes, and really for all women.

How Do You Feel About the Result?

Stephanie: “They’re so symmetrical, so nice and perky. It’s taken my confidence from probably a six to a ten. I feel beautiful, I feel strong, I feel confident. And at the end of the day, I’m still Stephanie Han. I’m still a world champion boxer, still a police officer, still a mother of two, still a woman of God. This doesn’t change who I am. It’s just something I wanted for myself.”

Is This the Recovery Every Patient Should Expect?

Dr. Agullo: It is realistic for most women having Preservé on its own. Back to work within one to three days, back in the gym at about two weeks, the way I have seen with many patients. If a patient also needs a lift, or is having liposuction or a mommy makeover with a tummy tuck, that changes everything, and the recovery is dictated by those other procedures. For the full breakdown of the technique, the implant, and the recovery ladder, I wrote that up in Back to the Gym in Two Weeks: Motiva Preservé and What Preservation Surgery Actually Means. The technique itself is on the Motiva Preservé page at agulloplasticsurgery.com, and the broader breast augmentation overview is on swplasticsurgery.com.

What Would You Tell a Woman Who Has Been Holding Back?

Stephanie: “This is one of the things I do not regret at all, and I honestly wish I’d done it sooner. Don’t listen to the stigma. You can still be strong, you can still be beautiful, and you can still perform at 100 percent. To every mom and every athlete, especially the women champion boxers and the moms who breastfed, if you have two weeks, you can do it.”

Ready to Talk?

If Stephanie’s story sounds like the version you want, the next move is a consultation. I will tell you whether Motiva Preservé fits your anatomy and your goals, and I will give you a recovery timeline I can actually defend. The goal is the body you recognize in the mirror, and a recovery you can plan your life around. #StayBeautiful.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. Follow along at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

May 21, 2026

Preservation, Not Minimalism: I Wrote a Manifesto for Connectively

Dr. Frank Agullo, MD, FACS, double board-certified plastic surgeon in El Paso, Texas, in black scrubs in the operating room examining a facelift candidate as part of the preservation-era technique described in his bylined Connectively article.

Preservation, Not Minimalism: I Wrote a Manifesto for Connectively

I keep hearing the same thing in consults. “Doctor, plastic surgery is going smaller now, right? Less volume. Subtler results.”

Half true. Mostly misleading.

Connectively just published my bylined piece on this, and I wanted to push back on the frame in my own voice here too. Volume has not gone anywhere. Patients in my OR this month still wanted fuller breasts. Fuller hips. I still placed implants. I still grafted hundreds of cc of fat per side.

What changed in the last decade is what we refuse to damage when we add that volume.

The Old Bargain

For thirty years, adding volume came with a quiet compromise we did not really put into words for patients.

Breast augmentation, the way I was first taught to do it in training, meant a wide pocket dissection. That meant cutting through the suspensory ligaments of the breast. Those are the fibers that hold the breast up against gravity. We took them down to make room for the implant and we did not think twice about it. The implant looked great at six months. At year five, the breast started to bottom out, and by year ten the patient was back asking what happened.

Gluteal fat grafting in its early era was a free pass. Pre-2015, the field grafted into and through planes that we now know are dangerous. Plenty of surgeons added beautiful volume. A subset of patients did not survive it. The complication that killed people was fat embolism, and the cause was depth, not volume.

Facelifts of that era depended on tension. We pulled skin tight over tissue that had already failed structurally. At one year the patient looked rested. At ten years the patient looked pulled. The lateral sweep. The wind-tunnel mouth. That look did not come from “too much” facelift. It came from a facelift that was working only at the surface.

We did not really articulate any of that to patients at the time. Two reasons. The long-term follow-up data on these trade-offs was incomplete, and in some cases still is. And we did not have reliable alternatives. So we delivered volume, and the side effects came due fifteen years later in someone else’s consult room.

I had the luxury, during my Mayo Clinic plastic surgery fellowship, of seeing both eras in the same hospital. The old habits and the new evidence in the same hallway. That bothered me then. It still drives how I plan a case now. So does the Ponytail Academy training I did later, intermediate course in Pittsburgh, advanced course in Santa Monica, which gave me a deep plane facelift approach that holds at year ten the way an earlier-era SMAS tightening simply does not. Thirteen consecutive Castle Connolly Top Doctor years (2014 through 2026) is a long enough patient sample to feel honest about that claim.

What Preservation Actually Looks Like in My OR

The word “preservation” gets used loosely. So let me show you what it actually means at a case-planning level, by procedure.

Breast Augmentation

I am using ergonomic, lighter implants now (Motiva is the line I use most, see my Motiva Preserve post for what the recovery actually looks like). They project differently, with less weight per cc on the native tissue. That alone lets me use a slightly smaller implant for the same on-camera result.

My pocket dissection is narrower. The suspensory ligaments of the breast, particularly the inframammary ligament along the fold, are preserved instead of divided. The dual-plane release is precise rather than broad. The implant sits where I put it and stays there, because the soft tissue scaffold underneath it is still intact.

My patient leaves the OR with a result that looks finished on day one. The deeper test is what the breast looks like at year five and year ten. That is what preservation buys.

Gluteal Fat Grafting

If you are a regular reader, you know I do not graft above three or four hundred cc per side without a reason. The reason for me is not volume restraint. It is plane discipline.

Every BBL I do is ultrasound-guided. The probe sits on the buttock while I am cannulating. I can see the fascia. I can see the cannula. I can see the plane I am working in, in real time. That is not optional anymore. That is the standard.

Three hundred, four hundred, five hundred cc per side is achievable safely now in carefully selected patients with the right anatomy. Volumes that fifteen years ago carried a risk profile I would not accept. The volume number is not the safety story. The plane is the safety story.

This is the era I trained into. I sit on safety task forces for the Aesthetic Society and the conversation is no longer whether to use ultrasound. It is which probe and how to teach it.

Facial Volume

Here is where most patients have the wrong mental model entirely.

The patient sits down and tells me, “I do not want to look puffy. I do not want filler face.” Good. Neither do I. So I am going to put more volume in your face than you think, just not where you are picturing it.

Aging is not a wrinkle problem. Aging is a volume-loss problem. Deep facial fat compartments empty out over decades. Bone resorbs. The midface loses structural support. The skin you can see is the last thing to fail, and tightening it without restoring what collapsed underneath is the wind-tunnel facelift I described above.

A preservationist face today gets more volume, placed deeper, in the compartments that actually emptied. Buccal extension. Deep medial cheek. Pyriform aperture. Done correctly, the patient does not look “added to.” They look like themselves, ten years younger, because the architecture is back. I cover the technique side of this in my Deep Plane and Ponytail Lift post on this same site.

The Face Volume Surprise

I want to sit with this one for a paragraph because it is the most counterintuitive part of the whole conversation.

Filler trends pushed in the opposite direction. We watched a decade of overfilled, surface-level work go viral. Patients walked into my office showing me Instagram screenshots of what they did not want. Reasonable.

The correction was not less volume. It was deeper volume.

Volume placed superficially, in the wrong compartment, without regard for architecture, gives the puffed, frozen, unnatural read everyone fears. Same patient, same milliliter count, placed in the deep medial cheek and along the bony pyriform: that patient looks rested, not filled. The volume restored structure. It did not distort it.

This is also why I keep telling patients that fillers, used the wrong way, are a tax. You pay every nine to eighteen months, and you slowly add surface volume in places that should not carry it. A correctly planned surgical fat graft, deep, compartment by compartment, lasts years and does the architectural job instead of the cosmetic one.

What To Ask At Your Consult

If you take one practical thing from this piece, take this. The question to bring to a consultation is no longer “How much volume can I get?”

The better one is “What do I want preserved?”

For a breast augmentation: ask the surgeon how wide the pocket dissection is, and how they handle the inframammary ligament.

For a gluteal fat graft: ask whether ultrasound guidance is used intraoperatively, and which plane they graft into.

For a facelift or facial volume restoration: ask which compartments they target, and at what depth.

A surgeon who answers in those terms is operating in the modern framework. A surgeon who answers only with the volume number, with no thought to what is preserved underneath, is using a thirty-year-old playbook on a 2026 patient.

I wrote the full version of all of this for Connectively, with examples and the broader case the field needs to make to patients. You can read it here.

Volume was never the issue. It never was. What we have learned, sometimes the painful way, is that volume and preservation are not in opposition. The craft is knowing precisely where to put what you add, and what you refuse to damage to get there.

That is the shift worth paying attention to.

Ready to Talk?

If you want to have this conversation in person, my office line is (915) 590-7900 and our text consult line is 1-866-814-0038. Book online at agulloplasticsurgery.com. Follow along at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, and @AgulloPlasticSurgery on Facebook.

#StayBeautiful

May 13, 2026May 31, 2026

Back to the Gym in Two Weeks: Motiva Preservé and What Preservation Surgery Actually Means

Editorial frontal before and after view of a Motiva Preserve breast augmentation with 315cc Motiva Ergonomix Full implants on a slim athletic young woman patient wearing a Dr. Worldwide bikini, breast augmentation by Dr. Frank Agullo, MD, FACS, double board-certified plastic surgeon at Southwest Plastic Surgery in El Paso, Texas.

The patient in the photos on this page walked back into her office the day after surgery. Two weeks later she was lifting weights again. Four weeks later she was running. The compression bra came off at three. None of those numbers used to be possible.

For most of my career, the honest answer to “when can I lift my kids” after a breast augmentation was four to six weeks. The honest answer to “when can I lift heavy at the gym” was six to eight. I gave those answers a thousand times. They reflected the real recovery from a traditional submuscular augmentation, where the pectoralis muscle is partially released to make room for the implant. The muscle heals. It just takes the time it takes.

I stopped giving those answers about a year ago. The reason is a technique called Motiva Preservé, and it has changed enough about how I plan a breast augmentation that I owe my patients a longer explanation.

What Preservation Actually Means in the OR

The word “preservation” in Preservé is a commitment. Smaller incision (2.5 to 3 centimeters, inside the natural shadow below the breast). The implant sits in front of the muscle and behind the breast tissue, held by the breast’s own ligaments, so there is no muscle release at all. A no-touch funnel so the implant never contacts skin on its way into the pocket. Less tissue dissection overall. The breast and chest wall handed back to the patient as close to their pre-operative state as the operation allows.

What patients feel is less swelling, less tightness, less of the bruised-rib soreness that traditionally defines the first week. The recovery curve compresses. The day-one experience now looks like the week-three experience used to look.

The case in the photos on this page was completed in under an hour in the operating room, under light sedation rather than general anesthesia. She walked out of the surgical suite the same morning and drove home (with someone else at the wheel) before lunch. That is not a marketing claim either. It is the operative report.

That is not a manufacturer claim. That is what every Preservé patient in my practice has told me, with a logbook that backs them up.

The Implant: Motiva Ergonomix Full

The implant in this case is a 315cc Motiva Ergonomix Full. Sixth-generation silicone gel, ProgressiveGel Ultima inside, SmoothSilk surface outside. The shape is what makes the Ergonomix line different from anything else in my OR.

Upright, the implant drapes into a teardrop that looks like real anatomy. Supine, on the back, it flattens and rounds the way breast tissue does. Nothing about its shape is fixed. The implant moves with the body the way tissue would. Patients describe the result as natural in a way I do not hear with older implant designs. That has shown up in my consult conversations and in the reaction shots my own patients send me a year later.

The Full profile is one of three Ergonomix projection options Motiva offers in the United States (Mini, Demi, and Full). For a slim athletic patient who wants visible projection but a natural silhouette, Full is the right end of the range. The 315cc volume was the result of careful sizing in the office. She did not want a striking change. She wanted proportion. For the full breakdown of the technique itself, the Motiva Preservé breast augmentation page on agulloplasticsurgery.com walks through every step.

Why I Stopped Promising Six-Week Recoveries

The single hardest number to defend in breast augmentation is recovery time, because the standard answer has been wrong for a long time. We told patients six weeks because that was the honest answer for the surgery we were doing. We are not doing that surgery anymore.

The Preservé recovery ladder, for a patient with this body type and this implant choice, looks like this. Day one: back to desk work, off the heaviest pain medication, sleeping upright. Day seven: showering, light walking, sleeping however she wants. Week two: back to lower-body gym work and short runs, with a sports bra. Week three: compression bra off. Week four: full upper-body programming, with the surgeon’s clearance.

None of those numbers come from a brochure. They come from the patients themselves, who tell me what they actually did, day by day, in the months after. I keep notes. I update the table I show in consults. The numbers have not slipped.

A Short Comparison

A simple way to see the difference:

Question	Traditional Submuscular	Motiva Preservé
Incision length	4 to 5 cm	2.5 to 3 cm
Muscle release	Significant	None (implant in front of the muscle)
Implant insertion	Hand placement	No-touch funnel
Back to desk work	5 to 7 days	1 to 2 days
Back to upper-body lifting	6 to 8 weeks	2 to 3 weeks
Compression bra	4 to 6 weeks	2 to 3 weeks
Shape behavior	Round or shaped, fixed	Ergonomic, position-responsive

The table flattens some real surgical detail. The full nuance lives in the clinical version of this post on agulloplasticsurgery.com (linked at the bottom of this post), where I walk through the operating room in more depth.

Who Is the Wrong Candidate

I will tell you who Preservé is not for. A patient with significant ptosis (drooping) needs a breast lift in addition to an augmentation, and the lift drives a different recovery curve. A patient with very thin tissue or a history of capsular contracture needs a more nuanced breast augmentation revision conversation. A patient who wants a dramatic enlargement well beyond what her frame supports is going to be unhappy with any technique, and I will tell her so before we book a date.

The right candidate is a patient with a reasonable skin envelope, a defined inframammary fold, and goals that lean toward proportion. The patient in the photos on this page is one of the easier candidates to plan for. Not every patient is.

Why I Trained on This System

I have placed thousands of breast implants going back to my plastic surgery fellowship at Mayo Clinic. Castle Connolly Top Doctor thirteen consecutive years. Clinical Associate Professor at Texas Tech University Health Sciences Center, where I teach breast augmentation to the residents I am responsible for. I do not adopt new techniques because a rep walks them in. I adopt them when the data and my own results justify the change.

Motiva earned FDA approval for its silicone gel implants in 2024 after years of leading the implant market in Latin America and Europe. I trained on the system directly before I placed an implant in a patient. I do not place a Motiva implant the way I place every other implant in my OR, because the technique is different and the implant rewards the difference.

One More Thing About Volume

Patients always ask about size in cubic centimeters first. The number matters less than the planning around it. A 315cc implant on the patient in these photos reads as proportional. The same 315cc on a different frame might read as dramatic. The same 315cc on a third frame might read as not enough. Size, projection, profile, the elasticity of the skin envelope, the position of the inframammary fold. All of those drive the answer to “what should the number be.”

The right surgeon will spend the consult walking you through that math. If the conversation starts and ends with a single number, you are in the wrong consult.

See the case on social: originally posted to Instagram and TikTok.

Ready to Talk?

If you are reading this on your phone and thinking “two weeks back to the gym sounds too good to be true,” the right next move is a consultation. I will tell you whether Motiva Preservé fits your anatomy and goals, whether 315cc is the right number for your frame, and whether augmentation alone is the right operation or whether you also need a lift. If the answer is “not the right time,” I will tell you that too. The goal is the face and body you recognize in the mirror. #StayBeautiful.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. For the longer clinical breakdown, see the agulloplasticsurgery.com post on this same case or the swplasticsurgery.com practice version. Follow along on social at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.